How doctors fail the dying, by Being Mortal author Atul Gawande
Surgeon, author of bestseller about our longer, but sicker lives and one of the world's most influential thinkers, Atul Gawande tells Fionnuala McHugh how doctors are failing patients who are dying from old age.
When Atul Gawande's book Being Mortal came out in the autumn of 2014, the marketing department at his American publisher expressed some concern; it wasn't exactly upbeat. The subject matter was clearly signalled in the subtitle: Illness, Medicine and What Matters in the End. Who, in the holiday season, would want to read a book about dying?
As it turns out, a great many people (including United States President Barack Obama, who was seen buying it in a Washington bookstore shortly after publication). Not only that: to the publisher's, and writer's, surprise, it was being bought as a gift. People were purchasing several copies and giving them to families and friends. The book immediately leapt into The New York Times bestseller list, where it remains; within two months its sales had exceeded the combined total of Gawande's previous medically related works, Complications (2002), Better (2007) and The Checklist Manifesto (2009).
Gawande, who is a surgeon and a writer for The New Yorker magazine, is addressing a global conundrum. We're all living longer but the quality of our lengthened existence is in many cases diminished. As he puts it in Being Mortal, "The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver's chance of benefit." Dispatches from those at the front are rarely encouraging. He quotes American writer Philip Roth, from his novel Everyman: "Old age is not a battle. Old age is a massacre."
In 2009, Gawande began exploring this final journey - the one some of his patients, both young and old, have had to undertake - with a sense of frustration and curiosity. He, a medical man, had no useful maps to give them as they painfully crossed mortality's frontier. Along the way, he interviewed more than 200 patients and their family members, and spoke to dozens of people involved in every aspect of care-giving in hospices, care-homes, assisted-living communities.
He did statistical research, much of it to do with the elderly: in the US today, there are as many 50-year-olds as there are five-year-olds but, between 1996 and 2010, the number of certified geriatricians in practice fell by 25 per cent. He delved into history. "Nursing homes" were originally built to house impoverished sick people who had nowhere else to go. They weren't intended to be the ultimate destination for a nation's senior citizens.